Tanzanian man with sickle cell disease undergoes revision total hip replacement surgery at Delhi hospital

He was admitted under the supervision of Raju Vaishya, senior consultant, Orthopaedics and Joint Replacement, at Indraprastha Apollo Hospitals here, and underwent first stage left hip revision surgery for underlying deep infection from the previous THR, the statement said.

A 33-year-old Tanzanian man with sickle cell disease received a new lease of life after undergoing a revision total hip replacement procedure at a leading private hospital in Delhi, doctors said on Monday. This was an ''extremely challenging case'' since the patient's condition was deteriorating fast due to severe infection, they said. The patient had previously been diagnosed with avascular necrosis (AVN) of the femoral head of the left hip, the doctors said. He had undergone left total hip replacement (THR) in his country. Following this surgery, he developed persistent deep infection and a discharging wound from his left thigh, one year prior to coming to Apollo hospital in Delhi, the hospital said in a statement. ''The patient developed discharge from the surgical wound and required debridement to remove debris and smoothen rough surfaces. Prior to the surgery, the patient had reported pain in his left knee, hip, and shoulder due to sickle cell disease,'' it said.

The infections in sickle cell disease are challenging to treat as the infecting microorganisms are difficult to eradicate in patients with this ailment, as also due to lower host immunity, doctors said.

Sickle cell disease is a group of inherited (genetic) red blood cell (RBC) disorders, where the haemoglobin is abnormal, which causes the RBC to become hard and sticky and look like a C-shaped farm tool called a 'sickle', they said.

On further diagnosis and tests here, it was found that the Tanzanian patient had loosening of the implants of the operated hip. He was admitted under the supervision of Raju Vaishya, senior consultant, Orthopaedics and Joint Replacement, at Indraprastha Apollo Hospitals here, and underwent ''first stage left hip revision surgery for underlying deep infection from the previous THR,'' the statement said. Sickle cells die early, which causes a constant shortage of RBC, leading to anaemia. Also, when these abnormally disfigured RBC travel through small blood vessels, they may block the blood flow. This can cause pain and other serious complications such as atypical infections (like in this case), thrombus, AVN and in severe cases acute chest syndrome and stroke, doctors said.

The prevalence of this disease is high among people of Sub-Saharan Africa, South Asia, the Middle East, and the Mediterranean. The sickle cell disease is also prevalent in India, and the highest incidence is found across central India, south-eastern Gujarat, and south-western Odisha, the hospital said. ''This was an extremely challenging case since the patient's condition was deteriorating fast due to severe infection. He underwent two-stage surgery here. In the first stage, a debridement (cleaning) of the infected joint was done and the previously implanted hip prosthesis was removed to cure the infection (caused by pseudomonas aeruginosa microorganism),'' Vaishya said. ''An antibiotic loaded cement spacer was inserted. Patient underwent this surgery and was discharged in three days showing no post-surgery complications,'' he said.

The second stage surgery was done after eradicating the infection in March this year, where revision THR was implanted. The patient recovered well after this surgery and started to walk pain-free, the hospital added.